Low-intermediate dose testosterone replacement therapy by different pharmaceutical preparations improves frailty score in elderly hypogonadal hyperglycaemic patients

Abstract

An open-label follow-up study of low-to-intermediate dose testosterone replacement therapy (TRT) was conducted in 64 overweight patients (aged 65-75 years) with late onset hypogonadism (LOH) and increased fasting plasma glucose (FPG). Patients were subdivided into four treatment groups: oral testosterone (T) (T undecanoate, 80 mg/d), transmucosal T (60 mg/d), transdermal T (30 mg/d) or no treatment (control), and evaluated at 0 and 6 months. FPG, hemoglobin (Hb), prostate-specific antigen (PSA) and total T were measured and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index was calculated. Body mass index (BMI), waist circumference, fitness level (6-min walking test), Aging Males' Symptoms (AMS) scale, handgrip strength and energy expenditure with physical activity (Minnesota questionnaire for Leisure Time Physical Activity (LTPA)) were evaluated and a "frailty score" (based on: grip strength, gait speed and LTPA) was calculated. T levels increased in all treatment groups; the oral T group had values still in the hypogonadal range (5.9 ± 1.1 nmol/L). PSA and Hb concentrations did not change in any group. BMI, waist circumference, FPG and HOMA-IR improved in all T-treated groups after 6 months, with a greater effect seen with transmucosal and transdermal T compared with oral T. This study indicates that low-to-intermediate dose TRT may be safely utilized in LOH patients to ameliorate somatic and psychological frailty symptoms in association with improved anthropometric and glycometabolic parameters in aging, overweight men with LOH and impaired fasting glucose.

Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults

“…In healthy, highly functioning older men with low-normal testosterone, transdermal administration of testosterone for 12 months, although having no effect on functional performance, improved fat mass, fat-free mass and upper body strength (Hildreth et al, 2013). In overweight older (65-75 years) patients with hypogonadism and increased fasting glucose, low-to-intermediate dose testosterone supplementation for 6 months, in addition to improve anthropometric and glycometabolic parameters in these patients, resulted in amelioration of frailty score determined by gait speed, grip strength and Minnesota questionnaire for Leisure Time Physical Activity (Strollo et al, 2013). However, no significant changes in strength or physical performance were produced by testosterone supplementation to older frail men despite inducing an increase in lean mass and a decrease in fat mass (Kenny et al, 2010b).…”

Guidelines for the Diagnosis and Treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus

“…Установлено, что восстановление тестостерона до физиологических уровней путем на-значения ТЗТ приводит к улучшению соматических и метаболических показателей у пожилых мужчин с ожирением, возрастным гипогонадизмом и наруше-ниями гликемии натощак [71]. Кроме того, терапия препаратами тестостерона оказывает положительное влияние на улучшение компенсации СД, что сопро-вождается снижением уровня гликированного гемо-глобина, инсулина и повышением чувствительности к нему [72,73,74].…”

Guidelines for the diagnosis and treatment of testosterone deficiency (hypogonadism) in male patients with diabetes mellitus (Draft)

“…Установлено, что восстановление тестосте-рона до физиологических уровней путем назначения ТЗТ приводит к улучшению соматических и метаболических показателей у пожилых мужчин с ожирением, возрастным гипогонадизмом и нарушениями гликемии натощак [71]. Кроме того, терапия препаратами тестостерона оказывает положительное влияние на улучшение компенсации СД, что сопровождается снижением уровня гликированного гемоглобина, инсулина и повышению чувствительность к нему [72,73,74].…”